Morton's Neuroma: When Your Forefoot Burns and Tingles

What is Morton's neuroma?

Despite the name, it's not actually a tumour. It's a thickening of the tissue surrounding the digital nerve between the metatarsal heads - most commonly between the 3rd and 4th toes.

The thickened nerve becomes irritated and compressed, producing characteristic symptoms: burning, tingling, or numbness in the forefoot and toes, sometimes accompanied by a sensation of stepping on a pebble or a bunched-up sock.

It's particularly common in runners who wear narrow shoes, run high mileage, or have certain foot types.

What causes it?

• Tight or narrow shoes - the most common cause. Compression between the metatarsal heads irritates the nerve.
• High-heeled shoes - shifts weight onto the forefoot
• Forefoot striking - repeated load on the metatarsal heads
• Hypermobile or flat foot - increases movement between the metatarsals
• Tight foot muscles - reduces the natural spacing between the toes

What it feels like

• Burning or tingling between the 3rd and 4th toes (sometimes 2nd and 3rd)
• Feeling like something is bunched in the shoe
• Symptoms that worsen later in a run and improve when shoes are removed
• Occasional sharp shooting pain into the toes
• Squeezed between the metatarsal heads, the forefoot click test is often positive

What helps

1. Wider footwear

The single most effective intervention. Running shoes and everyday shoes should have enough width across the forefoot to allow the toes to spread naturally.

2. Metatarsal pad

A small pad placed just behind the metatarsal heads (not under them) spreads the bones apart and reduces compression on the nerve. Available at pharmacies. Often dramatically effective.

3. Toe spreading exercises

Spread the toes wide and hold 5 seconds. Repeat 10 times. Trains the intrinsic muscles to maintain space between the metatarsals.

4. Calf and plantar fascia flexibility

Tight calf and plantar structures increase forefoot loading. Regular calf stretching and plantar fascia mobilisation reduce the compressive load.

5. Intrinsic foot strengthening

Towel scrunches, short foot exercise, single-leg balance. Reduces the hypermobility between metatarsals that aggravates the nerve.

Corticosteroid injection

A cortisone injection guided by ultrasound can provide significant temporary relief and is often used to break the pain cycle. It doesn't fix the underlying cause but can allow normal activity while you address footwear and load issues.

When to consider surgery

If conservative measures fail after 6–12 months, surgical excision of the neuroma is very effective (85–90% success rate). Recovery is 4–6 weeks.

Running during recovery

Running is usually possible with appropriate footwear and a metatarsal pad. Reduce forefoot strike if it aggravates symptoms. Running in a shoe with a wider toe box significantly reduces compression.